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HIV/AIDS General Info

This page encompasses several general topics of HIV/AIDS that you may find useful below:

HIV and AIDS Facts
AIDS Phobia – The new HIV?
HIV Notification Requirements
HIV in Singapore – Overview
The cost of HIV in Singapore
HIV/AIDS in Singapore – Virtually no HIV?

HIV Signs and Symptoms


HIV and AIDS Facts

HIV is an EPIDEMIC

HIV rates in Singapore has risen from 0.8 cases per 1 million population in 1985 to 118.1 cases per million population in 2007.(Singapore MOH HIV Statistics)

There are 33 Million people in the world living with HIV. (WHO UNAIDS Statistics 2007)

HIV is NOT A HOMOSEXUAL DISEASE

68% of all HIV cases in Singapore were transmitted by HETEROSEXUAL SEX. (Singapore MOH HIV Statistics)

HIV is DEADLY
In the world 2 Million people died from AIDS in 2007. (WHO UNAIDS Statistics 2007)

HIV is SPREADING

In the world, there were over 7400 new HIV infections a day in 2007. (WHO UNAIDS Statistics 2007)


AIDS Phobia – The new HIV?

While running a clinic that is part of the MOH anonymous HIV screening program, it is inevitable that I end up conducting a fair bit of HIV screening. In the course of my work I have noticed what I feel is a worrying trend of an increasing number of young Singaporeans with what is described as AIDS Phobia. It is an excessive and irrational fear of HIV/AIDS that is affecting their lives and function. A short history of HIV in Singapore will help us better understand the emergence of this consequence.

1985 was the year HIV first reared its ugly head in Singapore. Back then the medical community was brimming with confidence some might even say complacency, over our seemingly unstoppable successes against infectious diseases. From the advent of Penicillin to the eradication of smallpox, we were basking in the glory of our victories. No one even heard of the concept of the superbug and MRSA was but a mild irritant. Then this contagious and deadly disease that we had nothing against came. All our antibiotics were utterly useless and vaccine development met with failure after failure. It chewed through the very thing that helps us fight infections, our immune system. This left HIV sufferers vulnerable to bacteria that the healthy would normally brush off without a second thought. We saw patients literally dissolving around us and there was nothing we could do.

We quickly fell back on age old proven strategies to combat an infectious disease, epidemiology and education, isolation and prevention. An initial trend that was established found that HIV was more prevalent amongst homosexual men. It was also found to be spread amongst drug users who shared needles. This quickly established a notion in the conservative majority that HIV was a disease of the sexually or socially deviant. Education was focused on a campaign of fear. HIV is incurable, HIV is contagious, HIV is invisible. These were the catchphrases of the times.

Perhaps our efforts were too effective. Even at this day and age, misconceptions, incorrect ideas and social stigmas are as rampant despite our efforts at re-educating the public. This has led to the emergence of this new phenomenon. It has many names: AIDS phobia, AIDS anxiety, FRAIDS (fear of AIDS) etc. Psychologists argue over its technical definition. Is it a phobia? Delusion? OCD? Paranoia? Hypochondriasis?

Whatever you wish to call it, it is a problem that is growing in size. The internet is awash with examples of people not daring to go home for months because they are convinced they have HIV and will spread it to their family. And of people who bathe in the dark afraid of spotting lesions of their skin that are caused by HIV. And of people who wash themselves with bleach everyday to prevent HIV. All of them have had multiple tests for HIV and were found to be negative. In medical parlance they are known as the ‘worried well.’

I read with interest a report from China earlier this year were many people claimed to be suffering from a mysterious AIDS like illness. They were convinced the medical authorities were lying to them about their negative HIV tests. A few eminent experts stepped up and termed this crisis ‘prostitute guilt.’ I personally find it amazing how a new term can be conjured up to explain away the problem simultaneously placing the blame squarely on the heads of the patients. These poor souls are blamed for taking up precious medical resources unnecessarily and their underlying psychological illnesses are left to gnaw away at them.

I can however completely empathize with the Chinese medical authorities. In the course of my work I have encountered many patients suffering from this so-called AIDS phobia. It is challenging and extremely time consuming to help them and treat them. Each consultation becomes wearying task of addressing repeated fears and doubts, of reassurance, support and encouragement and of answering the same oft repeated questions.

I had a patient who, when he came to me, had been regular testing himself for HIV for the past 1 year. After each test he would feel relieved but within a few days, he would inevitably find another reason to believe he has HIV. Any and all symptoms he interprets as caused by HIV from the mundane (my tongue looks white) to the ridiculous (my semen smells like the prostitute). Despite numerous efforts to get him to seek and start psychological help, he was adamant in his pursuit for a diagnosis of HIV. He is of a group of patients who I describe as ‘wanting to test till they are positive’. Fortunately most of my patients who suffer from AIDS phobia are hardly as recalcitrant. They have insight to the fact that their fears are irrational and respond very well to treatment.

So here we are stuck in this conundrum. We want everyone ‘at risk’ to test regularly for HIV yet we do not want people to worry excessively about it. This places serious challenges in public education campaigns as we struggle with the balance of instilling concern, awareness and just the right dose of fear. We want patient to trusts our tests yet understand the window period. All this is made even more exigent by the deluge of information on the internet which is generic at best and outright lies at its most awful.

Of course the focus of our efforts should remain on creating awareness, pushing education and eventually, we hope, to eliminate HIV from our shores. But in our pursuit of this admirable quest, we should not forget this group of people who also suffer from HIV albeit from a completely different angle. Moreover, the majority of such sufferers are prime active economic contributors and the loss of their economic efficiency would mean a blow to our economic capability.

I hope we can strive to increase the awareness of this condition among Singaporeans and our primary care doctors. We can all guard against it by educating ourselves on the facts of HIV, trusting our Doctors and our tests and being more aware.


HIV Notification Requirements

(INFECTIOUS DISEASE ACT OF SINGAPORE) If a person is tested positive for HIV, these are the notification requirements:

  • HIV positive people are required by law to disclose their HIV status to their sexual partners before engaging in sexual intercourse.
  • HIV positive people are recommended to disclose their HIV status to medical and dental personnel performing invasive procedures on them.
  • The HIV positive person is encouraged to get his/her sexual partners and others who might be exposed (such as children of HIV positive mothers) to test.
  • The person will also be referred to the Communicable Disease Centre (CDC) of Tan Tock Seng, which is the national referral center for HIV/AIDS for further management.
  • Apart from the above situations, no one (including employers and other family members) will be notified, as the Infectious Disease Act protects the identity of HIV infected people and prohibits the unwarranted disclosure of information, which can identify someone as being HIV positive.


HIV in Singapore – Overview

Human immunodeficiency virus (HIV) is a worldwide pandemic. It reached our shores in 1985 with the diagnosis of the first HIV patient in Singapore. It has since developed into what UNAIDS terms a ‘low-prevalence epidemic’ with 4000 people living with HIV/AIDS out of a population of 4 million i.e. a HIV prevalence rate of 0.1%. This same agency also estimates Singapore’s HIV prevalence rate to be closer to 0.3% with a ‘high-estimate’ of 0.5%. This frightening statistic was supported by a study that conducted HIV tests on unused blood specimens in Singapore hospitals. The rate found in the study was 0.28%.

The majority of people diagnosed and living with HIV/AIDS are between 19 and 49 years old. They come from our most economically productive segment of the population.

This terrifying trend is likely to continue if not worsen. Many of our political leaders and experts in the field of HIV have warned that, if not checked, Asia, and Singapore, might very well go down the road that Africa has gone. There is no need to reiterate the horrific economic and social consequences that many African countries currently have to struggle with that is a direct result of the HIV/AIDS pandemic.

HIV/AIDS is indeed a unique disease. In the past half century, modern medicine has won victory after victory over bacteria and viruses. For a long while there was no such thing as an incurable infectious disease; until HIV. To be able to catch an incurable disease we can neither see nor smell nor hear nor taste nor touch from a fellow human being is repulsive and absolutely frightening to our psyche. Furthermore, HIV is caught through having sex which is a taboo subject with the conservative majority and a sin amongst some within the religious community.

Singapore is unique in the sense that through good governance and policy, we have managed to virtually eliminate HIV transmission via tainted blood products, sharing of needles amongst drug users and HIV transmission from mother to child. This means we are only left with tackling that HIV transmission through sexual contact.

This also means having to engage a segment of the population that most people will find distasteful at best and outright disgusted at worst. These are people who visit prostitutes, people with multiple casual sex partners and men who have sex with men (MSM).

It is time to put aside all the bigotry and prejudice, to stop blaming people for catching HIV, to stop grumbling about how government agencies do not communicate with each other, to stop whining about violation of human rights, to stop bellowing about repealing 377A. We need to stop ignoring and ostracizing and start engaging and educating. We need to find creative means to reach out to communities at risk within the confines of existing laws and policy and at the same time not affront the senses of the conservative majority.

HIV/AIDS affects us all Singaporeans, directly and indirectly.

Stop blaming, start helping.


The cost of HIV in Singapore

A recent report by WHO, UNICEF and UNAIDS stated that only 1 out of 3 people in the world living with HIV has access to life saving anti-HIV drugs.

Our neighbor Cambodia has achieved universal access for it citizens to fully subsidized HIV treatment which is truly remarkable.

Singapore is in a unique situation where everyone has access to anti-HIV drugs. We are not plagued by supply chain problems and lack of trained medical personnel like some of the other less developed countries. However, the issue still remains that many Singaporean living with HIV are unable to afford these life saving medicines.

A report published in 2006 in the International Journal of STD AIDS stated that the cost of Life Years Gained for people living with HIV in Singapore between 1996 and 2001 ranged from S$10,000 to more than S$20,000 per year depending on the stage of infection they were at. This situation has not changed much as cost of anti-HIV drugs is currently about S$1000 per month. This does not even take into account costs of tests and treatment for other HIV related illnesses like TB.

It is heartening to see our Ministry opening up Medisave and Medifund for use in HIV treatments but having to pay more than S$1000 per month for medication is still a struggle for the average Singaporean. This is assuming that they even get to keep their jobs which is often not the case.

Minister Khaw has made the call for life saving anti-HIV drugs to be included in the list of subsidized medications. This will truly be a significant milestone in our fight to eradicate HIV from our shores.

I can understand why the conservative majority of Singaporeans will be against using our tax dollars to help people living with HIV. After all they ‘brought it upon themselves’ and have to ‘pay for their mistakes’. However, it is my humble opinion that we need to look beyond this and see the bigger social picture. Having access to affordable medicines will help keep people living with HIV on treatment and therefore lower the chance of them spreading HIV to others. Also, knowing that there is affordable treatment available will encourage more people to come forward for HIV screening and lower the rate of unknowing transmission.

I look forward to the day Singapore joins the ranks of countries that provide universal access to subsidized HIV treatment.

References:

Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector by WHO, UNICEF, UNAIDS. 28th September 2010.

Int J STD AIDS. 2006 Oct;17(10):699-705. Cost and cost-effectiveness of antiretroviral therapy for HIV infection in Singapore. Paton NIChapman CASangeetha SMandalia SBellamy RBeck EJ.


HIV/AIDS in Singapore – Virtually no HIV?

“If we do not act, by 2010, we may have more than 15,000 HIV persons in Singapore. Then, sometime in the next decade, Tan Tock Seng may very well become the AIDS hospital.” Dr. Balaji Sadasivan during a speech delivered in 2004 at the Tan Tock Seng Hospital Doctor’s Night.

I read with great sadness about the passing of Dr. Balaji. Reports of his efforts and visionary leadership with regards to controlling HIV/AIDS in Singapore brought to mind a beautiful book by Dr. Elizabeth Pisani I once read titled ‘The Wisdom of Whores.’ It was a great read, simultaneously engaging and thought provoking. I was however rather tickled when she described Singapore as a ‘hyper-organized Asian city state….well stocked with indigenous talent, and there was virtually no HIV.’

It got me thinking about how the rest of the world perceives Singapore through the HIV looking glass. Does everyone hold the impression that Singapore has ‘virtually no HIV’? It would genuinely come as a complete non-surprise if they do. Singapore exudes an image of cleanliness, efficiency, wealth and, dare I say, purity. There is no corruption, no drugs, no development problems so why should there be HIV? In fact, I’d be willing to wager that most Singaporeans feel the way most of my friends and acquaintances do, that although HIV/AIDS in Singapore should be dealt with but it’s really not such a big problem.

As a typical Singaporean obsessed with ranking, I trawled the internet for any information on our HIV ranking in the world. According to Wikipedia, Singapore ranks 113th in terms of total number of people living with HIV/AIDS but due to our small population size, we rank 94th in terms of prevalence. Not too bad out of 168 countries. We are a little better than Malaysia (81st) and a lot better than Thailand (49th). We however lag behind Indonesia, Philippines, China and India just to name a few. Of course Wikipedia may not be the preeminent authority in epidemiological accuracy.

With the leadership of the late Dr. Balaji, Singapore has won many victories against the spread of HIV. An efficient blood transfusion service, potent anti-drug laws and universal and routine HIV screening of pregnant women have all contributed to controlling the epidemic. Yet we can ill afford complacency. In 2008 Singapore’s MOH reported 3941 people living with AIDS but we now suspect the actual number is closer to 3 times that. This has been estimated by UNAIDS and supported by a study on unused blood samples in Singapore hospitals. This implies that there could be up to 8000 people living with and spreading HIV unknowingly in Singapore. This is a frightening prospect indeed.

Our own clinics have conducted more than 2600 HIV tests since we attained the mandate for anonymous HIV testing in November 2008. And the statistics are staggering. We reported a HIV positive rate of 0.75% which is more than twice UNAIDS’ estimate and more than 7 times the current reported infection rate in Singapore. It can be argued that the people who choose to undergo anonymous HIV tests are the ‘at risk population’. But this is still higher than any of the estimates for the so called ‘high risk groups’. 85% of the HIV positive individuals in our study were between the ages of 20 and 49 years old, presumably our most economically productive. 42% were heterosexual.

So why are these 8000 or so people not coming forward for testing? There are without doubt numerous barriers to HIV testing. A team of researchers from the University of Washington has cleverly compartmentalized them into barriers associated with individual concern, with programs, policies and laws and with counseling and testing strategies. The introduction of an anonymous HIV screening program in Singapore has removed one of the largest barriers to testing. This leaves essentially the barriers related to the fear of segregation, discrimination, lack of availability and affordability of treatment, and the lack of perception of HIV risk, the ‘individual concerns’.

On 1st December 2009, World AIDS Day turned 21. In most countries, this is a legal age for suffrage. It is then perhaps timely and appropriate that the sub-theme for the year’s World AIDS Day is ‘Universal Access and Human Rights’. The so-called ‘I am – theme’. I am accepted.I am safe. I am getting treatment. I am well. I am living my rights. Everyone deserves to live their rights. Right to Live. Right to Health. Access for all to HIV prevention treatment care and support is a critical part of human rights.

The empowerment of people living with HIV/AIDS might leave in bitter taste in your mouth if you fall into the virtually all-encompassing portion of the population known as the ‘conservative majority’. However, even the most bigoted amongst us must accept the scientific fact that only people with HIV can spread HIV. It is also fact that people who know their HIV status are more likely to take precautions to protect their partners from contracting HIV. And since a high viral load and concurrent STD infections makes a HIV infected person more contagious, treatment of the HIV to lower the viral load and treatment of any STDs will decrease the chance of the HIV infected person from spreading HIV. It is therefore rational to conclude that helping people living with AIDS and removing stigma and barriers to allow more people to come forward for testing and treatment will in turn lead to a decrease in prevalence of HIV in the country and thus protecting all of us. Blaming, segregating and ostracizing will only lead to more people deliberately choosing ignorance and ignorantly continuing to spread HIV. We can venture that if people at risk know that there is support, available and affordable treatment rather than damnation, they would be much more prepared to come forward for testing and treatment. Of course, crucial to its success is the imperative need for resources and talent to be committed to enhancing said support. The message of HIV prevention, testing and treatment then can be broadcasted through a campaign of education and not fear mongering.

This brings to focus the debate of which is better: a campaign targeted at the general population or a campaign targeted at high risk groups only? Admittedly from an economic efficiency perspective, a targeted campaign will most likely have a higher yield for a lower cost. However, it will potentially contribute to further exclusion and segregation. Furthermore, many people who are at risk do not consider themselves to be in these ‘high risk groups’ (which incidentally are commercial sex workers, their customers and men who have sex with men). These are not the fiends we picture with unshaven faces, lecherous glares and that unforgettable gloating laugh as he rubs his hands in glee while preparing for another session of debauchery. These people could very well be our friends, our colleagues, our spouses, our bosses. And they would more likely be incredibly offended if they were targeted by a HIV education campaign aimed at ‘high risk groups.’ Making HIV testing special is segregation in itself. It everyone is educated about HIV and we can all talk about it openly with out embarrassing giggles and we can all walk in to a clinic and ask for a HIV test without glancing furtively over our shoulders then another gigantic barrier to HIV testing and treatment will be shattered.

Support and provision for people living with HIV/AIDS is critical but in spite of that, the old adage ‘prevention is better than cure’ still holds true. Even the most obstinate proponents of condom use must admit that the 2 unquestionably foolproof ways of preventing oneself from catching HIV are total abstinence and staying in a mutually monogamous relationship. This is why in spite of all the rhetoric by epidemiologist that preaching abstinence to our youth does not work, preach abstinence to our youth we must. Even if the message only gets through to 10% of them, it translates to 4000 of our children per year (based on an approximate of 40,000 live births per year) that absolutely and positively will not get HIV or any other STD. That is 4000 of our children per year that we do not have to spend a cent on anti-retro viral treatments or STD treatments or social support or counseling or any of the other multiple support elements that people living with HIV/AIDS require. All this achieved by sending well trained educators to each and every one of our schools and teaching our children to ‘do the right thing’.

So what happens to the other 90% (or 99% for the more cynical amongst us)? We will just have to teach them to use condoms. I apologize to the conservatives and traditionalists but we just cannot argue against scientific fact. Condoms might not work a100% of the time but they sure are better than nothing. Significantly better in fact. Using condoms not only prevent a HIV negative person from contracting HIV, it also prevents a HIV positive person who is unaware of his/her status to unintentionally spread HIV.

So here we are in 2010 and it would seem Dr. Balaji was right when he predicted the scale of the epidemic 6 years ago. I believe he would have wanted his passing to be a call to arms to galvanize our efforts to rid Singapore of HIV. We now stand at the cross roads where we can decide if Tan Tock Seng Hospital truly becomes the next AIDS hospital or Singapore truly becomes an island state with virtually no HIV.

advise


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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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45 Comments

  1. Jaco Wong

    Hi Doctor Tan

    I am just curious is it possible for HIV flu symtoms to be gone in a day?
    I know it sounds a stupid… hahha
    But, I just want to calm myself down.
    Thank you so much for your time
    Jaco from Hong Kong

    • Not all patients who are infected with HIV will develop sero-conversion symptoms.
      Your symptoms maybe because of other medical conditions.
      However if there was risk of exposure, I suggest that you talk to your doctor about HIV testing.

  2. plzzzzzzzz help me

    Hi Dr tan
    recently I fucked a ladyboy my worry is about I kept lot of lip to lip kisses deeply and my lip touched deeply to ladyboy tounge and lip and also I suck her tits so if she had hiv how much chance dat hiv transmits to me plzzzzzzzz give ur valuable reply.note-i wore a condom ven I fuck in anal

    • drtan

      Dude, I would appreciate it if you were a little less crude as a courtesy to other users of this forum. Thank you. You had protected anal sex with a transsexual person. This already puts you at risk of HIV. I think you need to adjust the focus of your anxiety.

      • plzzzzzzzz help me

        Sir tell clearly nw I’m at risk or not I fucked dis ladyboy at desker road brothel house

        • drtan

          This is my last friendly warning to you. Please stop using foul language. If you persist with this I will ban you from this forum. Let me be very clear: YOU ARE AT RISK OF HIV.

  3. plzzzzzzzz help me

    Hi Dr Tan,
    recently I fucked a ladyboy my worry is about I kept lot of lip to lip kisses deeply and my lip touched deeply to ladyboy tounge and lip and also I suck her tits so if she had hiv how much chance dat hiv transmits to me plzzzzzzzz give ur valuable reply.note-i wore a condom ven I fuck in anal

  4. Hi dr tan I’ve finger a prostitude not long ago. I do not realize I have blood on my finger cos I bite finger nail but those blood stain are dry may I know what are my chance of getting aids or HIV?

  5. AmIworried

    Sorry, I am referring to my friend, not me. That is what he told me.

  6. AmIworried

    Hi, doctor. I would just like to ask, that is if last 2 years, I had about 1-2 partners(one in last year, another one, and did some oral sexual things, but they are clean, and I do not feel anything wrong for the past 2 years, and I remembered that there were no penetration and no blood. There is nothing to worried right? Since im not a victim of hiv.

  7. Hi doc,

    May i ask a question: Iet say the water at the WC get into a person anal as it has not flash by the previous user will that person get infected with HIV and STD?Where the place is DSC where a lot of going there for test. Sorry for my poor English

    The whole situation is I wanted to do my “big business” and while release my stool it hit the water and water splash to my anal. Problem is it have not flash by the previous user and i’m afraid the previous user might have virus and contain it in the water. And unfortunately the water hit my anal when I used it.. The place is at DSC where many people go there for STD and HIV check.

    May I know am I in risk?

  8. Hi doc,

    May i ask a question: Iet say the water at the WC get into a person anal as it has not flash by the previous user will that person get infected with HIV and STD?Where the place is DSC where a lot of going there for test. Sorry for my poor English

    The whole situation is I wanted to do my “big business” and while release my stool it hit the water and water splash to my anal. Problem is it have not flash by the previous user and i’m afraid the previous user might have virus and contain it in the water. And unfortunately the water hit my anal when I used it..

    May I know am I in risk?

  9. Hello Dr Tan,

    I have to say I dislike your use of rhetoric in illustrating how preaching abstinence is good.

    “That is 4000 of our children per year that we do not have to spend a cent on anti-retro viral treatments or STD treatments or social support or counseling or any of the other multiple support elements that people living with HIV/AIDS require.”

    You say a very small minority will listen, that minority is probably the minority that will not even have premarital sex or will only listen when they are young and impressionable. Furthermore, our main source of local HIV infections are from the gay community and unlicensed sexual workers. Kids are largely unexposed to those sources. For them it’s mainly birth control, I won’t elaborate too much but much like protection from HIV, abstinence is not birth control.

    Most people who contract HIV are usually promiscuous and telling them to be abstinent is ineffective(they don’t care), also when one is in a particular moment logic can fail to kick in sometime. That is why promoting the use of ACTUAL safe sex with the use of condoms is important. People are going to have sex anyway regardless of whether the current government campaign is to speak better chinese, to speak better english, or to be abstinent.

    Condoms are highly effective, not too expensive and easy to carry around with you. Promoting abstinence is fine (no harm right?) but the main message has to be safe sex as opposed to no sex because I said before, people are going to have sex anyway.

    However, I do agree with you on the point that Singaporeans in general need to be educated. They need to be educated on what HIV is, how it can be spread and the need to go for regular testing if they have multiple partners. I too believe that the figure is higher than the official statistics and that most of those don’t even suspect that they have it.
    Sex is a taboo subject but mostly only for the older generation, for the younger generation not so much. The government is the one that needs to move forward to educate.
    The social stigma of having HIV is bad enough in more open countries, in Singapore it’s pretty much a death sentence i’d imagine.

    – Don

    • Hi don,

      Thank you for your insights. I would like to know where you got the data that ‘our main source of local HIV infections are from the gay community and unlicensed sexual workers’. According to the MOH update in 2010, 52% of newly diagnosed HIV cases in Singapore was from Heterosexual transmission. I see no mention of whether HIV was contracted from licensed or unlicensed sex workers or casual partners. Also please share with us the data behind your statement ‘Most people who contract HIV are usually promiscuous’. These are strong statements and I am very interested to know your source of information. I would be very grateful if you could share it with me. I completely agree with you that promoting safe sex is very very important and I wish our government would place more empahsis on that in addition to the message of abstinence (because realistically, our government is never going to give up the abstinence message). So what I am hearing from you is that you think we should not teach our children abstinence at all? I know patients and friends who are HIV positive and living in Singapore. They give me the impression that it is not so bad. Of course I am not the one going through it so it will be very unfair for me to comment. Perhaps someone living with HIV in Singapore can share with us their experiences and let us know if it is the ‘death sentence’ that most people imagine it would be.

      rgds

      Dr Tan

      • Hello,
        In that same progress report you mentioned, majority of those who have been newly diagnosed with HIV are males, a vast majority in fact.
        “As at end June 2009, there
        were 3,729 male cases and 430 female cases, giving a sex ratio of nine males to
        one female.”
        Considering the fact that the chances of contracting HIV from female to male is significantly higher than male to female, it would be safe to assume that HIV is not primarily spreading within locals. Furthermore, with the strict medical checkups on local brothel-based sex workers along with a high rate of condom use, it is unlikely that it is the main source of infection; this is one thing that the government has gotten right. With these probabilities, it would be safe to assume that these infections either come from locals who travel to neighboring countries to have sex with prostitutes over there who are a lot more likely to have HIV and not use a condom. These guys come back, have HIV, and maybe some of them have relations with local women. This would explain the significantly higher amount of males with HIV. It would be highly unlikely that if HIV was spreading primarily through locals that the difference would be so large.

        Regarding the statement I made regarding probable promiscuity amongst HIV positive individuals. Firstly I’d like to say that I am not saying all HIV positive individuals are promiscuous, it’s just more likely. I refer back to the above information that I provided. I consider visiting prostitutes promiscuous. Maybe you have some individuals who make a one-off drunken mistake and unfortunately get HIV, but HIV is not as easily transmitted as the media portrays it to be and it usually takes multiple exposures. Amongst the locals who get HIV from locals, the multiple exposure theory also supports my statement that individuals who contract HIV are usually promiscuous.

        I dislike fear-mongering. I don’t like the statement I quoted in the first post, in reality an abstinence campaign will probably cost more and result in saving no lives. Children are at practically zero risk in obtaining HIV if they are having sex with each other, this is a fact. I remember having sex education when I was 12, I do not remember a single thing they told me. All I remembered was the class laughing.

        Tell people the facts, don’t tell them YOU HAVE SEX = AIDS = BETTER OFF DEAD, which is what the government does. Telling people not to have sex is ridiculous, it is not a need in the sense that we need to have food to survive but having sex is healthy for the mind and body.
        I believe that abstinence should be preached to kids, in regards to birth control. But along side condom use, because children are impulsive in general. I cannot stress the importance of emphasizing condom usage if any campaign takes place.
        I am not against abstinence, but it’s not practical to apply this to our increasingly westernized society. People are not waiting until marriage anymore. As regards those who are actually abstinent, I have not met a single abstinent person who is that way because they are scared of catching STDs, their reasons are usually emotional and religious. I am talking about people 20 and up. Although it might be anecdotal and not a valid source of evidence, it is worth something. Have you met anyone who feared sex because of STDs?

        To conclude, fear of sex is not the way to go, providing the hard facts regarding STD transmission along with emphasis on how much a condom can protect you from them is the way to go. It’s not encouraging sex, people are not going to suddenly be promiscuous just because the government told them how to have safe sex. It’s practically censorship to downplay the importance of condoms. I dislike it when people say that “Condoms are not 100% effective, so it’s better to not have sex at all”. Maybe practically speaking it’s true, no chance of STDs or unwanted pregnancies. But realistically people want to have sex, and if they think to themselves “Oh condoms do nothing, it feels better without one and I save money might as well do without it.” This is not the kind of mindset we want our society to have.

        -don

        • Hi don,

          I’m afraid you have made a significant factual error. HIV transmission from Male to Female is signficantly higher than from Female to Male. There are numerous studies to back this fact. If you know of a published scientific paper that states otherwise, please let me know.

          rgds

          Dr Tan

  10. Lost soul

    Dr tan,
    I had unprotected sex with ktv hostess 4weeks ago, I did normal HIV blood test on the 22 day and a rapid test on the 28th day. Both negative, need to know how accurate is my current status? Thanks

  11. Dear Dr Tan,
    I am one of the statistics of HIV sufferers. I would like to reach out to others in our community with the same condition. Would like to share with them stories and stigma they are currently facing. How they are couping with the cost of medications.

    warm rdgs

    • Hi CSC,

      I am so happy that you wrote in. I’m sure everyone on this forum including myself will be very interested to hear your story. Please email me anything you want to share to [email protected]. I will publish it as a post on the blog. Of course it will be kept anonymous and signed off as ‘CSC’. In fact, if you know of any other people living with HIV who wants to share their story, please ask them to write to me too.

      rgds

      Dr Tan

  12. This is a great page.
    And you’re a very kind soul.

    God bless.

    • Hi Propoz,

      Thank you very much. I’m glad you find our site useful.

      Rgds

      Dr Tan

  13. Hi Dr Tan,
    Would like your advise on this incident.
    I am a musician. I was at an instrument repair guy house on Sunday night. He is an white American who live here for quite a while. I was there to repair my instrument. He was showing me the problem , he used his thumb to press hard on a particular part with pressure & then asked me to use my thumb to press on it with pressure as well. Now, this s the thing, I saw some red stuff on the instrument part & stupid me without thinking about it I pressed on it. I realized after awhile that he had an “old” cut or wound on his thumb. Seems like cut during his repair job. After a while, I rushed & washed my thumb with anti bacterial hand soap & water. I am sure that my thumb as no cuts & sores. Dear Dr Tan, Is there anything to worry about? Any risk? Do I need to test for anything including HIV? Thank you very very much. Hope to hear your reply really soon.

    • Hi JTH,

      That is serious paranoia man. You are at risk of nothing. Especially not HIV. Forget about it.

      Rgds

      Dr Tan

      • Hi Dr Tan,

        Thank you for your reply. I know i am a little paranoia. However, Just to make sure one last time.I am quite sure that the red stuff on the instrument part is the blood of the repair guy from his “old” cut/wound, SO, do you still think that there is no risk of infection esp HIV??

        Really appreciate your quick reply.

        Thank you very much

  14. Hi Dr Tan,
    Would like your advise on this incident.
    I am a musician. I was at an instrument repair guy house on Sunday night. He is an white American who live here for quite a while. I was there to repair my instrument. He was showing me the problem , he used his thumb to press hard on a particular part with pressure & then asked me to use my thumb to press on it with pressure as well. Now, this s the thing, I saw some red stuff on the instrument part & stupid me without thinking about it I pressed on it. I realized after awhile that he had an “old” cut or wound on his thumb. Seems like cut during his repair job. After a while, I rushed & washed my thumb with anti bacterial hand soap & water. I am sure that my thumb as no cuts & sores. Dear Dr Tan, Is there anything to worry about? Any risk? Do I need to test for anything including HIV? Thank you very very much. Hope to hear your reply really soon.
    reply

  15. I’m sorry Dr Tan.

    I’m just very nervous, and all the answers that I’m getting from all over the place, always tells me the same thing. That symptoms are inconclusive.

    In your honest opinion, do night sweats from HIV show up 2-3 years from time of initial exposure and infection?

    I’m starting to understand that they might be caused by other illnesses, (hypoglecimia (or how that’s spelt), though I’m not a diagnosed diabetic, THOUGH I have a family history of diabetes) and also stress and anxiety, and it maybe in my best interests to get tested for HIV to rule it out (though its hard for me to see it from that angle yet).

    Is it true that the doctor might not let the patient take the HIV test if he feels that the patient is not ready for a HIV positive diagnosis?

    • Hi Fred,

      You really need to stop this. Just go get a HIV test. Asking all these questions is not only not helping you, it is making things worse. If you continue on this path, I’m afraid you will end up needing psychiatric help.

      rgds

      Dr Tan

  16. Hi Dr Tan,

    You mentioned this, “My HIV pick up rate is about 1% to 2%. This does not mean your risk of HIV is the same.”

    What do you mean by the second line?

    And when you talk about the symptoms “do not sound like they are caused by HIV”, do you mean that nightsweats have to be drenching, and fatigue has to be debilitating?

    Thanks.

    • Hi Fred,

      It means just because I diagnosed 1 to 2 cases of HIV positive individuals for every 100 people I test, does not mean that there is a 1 to 2% chance that you have HIV. So when you ask me what my pick up rate is, it is purely academic and has nothing to do with your situation. For example if you ask a hospital what is their colon cancer incidence and they say 1 in 1000 does that mean your chance of getting colon cancer if you go to them for screening is also 1 in 1000? Of course not. No. I mean they do not sound like HIV. Whether or not they are caused by HIV nobody knows.

      rgds

      Dr Tan

      • Thanks for your kind words Dr Tan.

        I ask for your opinion on home, DIY self test HIV 1+2 test kits.. Managed to get my hands on a number of them, though they are still lying in the corner and I’m unsure as to whether I should use them.

        Thanks.

        • Hi Fred,

          I am not a fan of home HIV test kits. Too many things can go wrong. Best to see your doctor.

          rgds

          Dr Tan

          • Hi Dr Tan,

            Sorry to seem so persistent in my replies.

            I don’t know if you would have a problem in answering this question due to confidentiality issues or anything, but what is the general profile of a HIV+ individual you tested?

            I think fear is getting the best of me, and causing me to be at my wits end.

            Fred.

          • Hi Fred,

            Seriously man. I refuse to answer this question. So what if I give you a profile that exactly fits you? Does that mean you definitely have HIV? This is not Criminal Minds. Just go get tested and get it over with. Bite the bullet man.

            rgds

            Dr Tan

  17. Hi Dr Tan,

    Reading about the costs of HIV treatment are turning me off from testing.

    As of October 2011, I have not visited a commercial sex worker cause I’ve developed a fear. Prior to that, I have been visiting them at times occasionally and at times frequently, on and off, for a period of 3 years. I’ve never thought of being tested prior to developing this fear.

    As of November 2011, I developed weird symptoms, some lasting to this day.

    1) Weird nightsweats which come and go. Its not drenching, and seem to be solved by blowing the fan directly at me, however, I have never seem to experience them prior to now.

    2) Prior to changing my toothpaste to one for dry mouth, the sides of my inner cheek, in particular the left buccal mucosa, seem to peel or slough off at times. After the change in toothpaste, it doesn’t seem to happen anymore. I do not want to jinx it but it has been ok (in that i do not notice peeling) for 3 days now.

    3) My skin seems to be rather dry, as of late, in particular the areas behind my arm.

    4) I have this weird twitching which seems to effect general areas all over my body (thigh muscle near to the knee, feet occasionally, forearm near the elbow, etc.)

    5) Fatigue. However, if I have something to do, I seem to forget this and I can generally function according to past levels.

    A question I have for you, in part for wanting to ally my fears and to eventually get tested is, according to your expert opinion and experience in testing people for HIV, how many cases, or rather an estimated average, do you see test positive, because they frequent prostitutes or commercial sex workers, even though they claim that sex was mostly protected?

    I’m just scared of getting tested because of the stigma and the potential costs of HIV treatment. I envy people living in developed countries such as US and UK, who do not have to think twice about going for a HIV test, and even people in DEVELOPING and UNDERDEVELOPED countries, such as Cambodia and Malaysia, who have subsidized HIV treatment options! What are we as a nation!

    Fred.

    • Hi Fred,

      My HIV pick up rate is about 1% to 2%. This does not mean your risk of HIV is the same. If it makes you feel any better, your symptoms really do not sound like they are caused by HIV. There is really no use talking about risks and percentages. You just need to pluck up the courage and go get tested. It is what it is. I really do not think it is any easier for someone in the US or UK or Malaysia to go for HIV testing. It is always a daunting task. I get posts from all over the world and everyone is just as afraid. I defnitely agree with you that in Singapore there is more that can be done to help HIV positive people. We seem to be moving slowly but surely in that direction. Fighting HIV stigma is a world wide problem.

      rgds

      Dr Tan

  18. Hi doc

    What the percentage that was affected with HIV or STD in the recent 2011? Is it alot peoples in Singapore diagnosed with those virus?

  19. hi,
    do i need to book an appointment before coming down for anonymous hiv test?
    how much will the test cost me?

    • Hi Jay,
      No you do not need an appointment.
      Tell our nurses at the counter you are here for a ‘3-Step Test’
      The test costs $50
      Dr Tan

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